| NPI | 1467823971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MD 30180) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A4331) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2024-11-04 |